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THE CLIFF LATEST: SPEAKER OPEN TO MORE REVENUES – House Speaker John Boehner privately told President Barack Obama he can go higher than the $800 billion the GOP has already pitched in new revenues, but only if the White House supports deeper entitlement cuts, according to sources familiar with the talks. The White House so far is sticking with $600 billion in entitlement cuts and $1.4 trillion in revenues — but Republicans insist they’ll never pass a revenue increase that large. So, Republicans are thinking about plan B: Extending Bush-era tax rates for families earning under $250,000 while waiting to address revenues and entitlements in next year’s debt limit increase. The POLITICO story: http://politi.co/RpUUvZ

Happy Thursday and welcome to PULSE, where we’re seeing signs that health care rhetoric is maybe, possibly starting to cool off. For the first time in four years, health care wasn’t at the center of PolitiFact’s “Lie of the Year.” Progress!

“We never get together at all until the last PULSE of Hanukkah”

TODAY ON POLITICO PRO:

--NO PLAN B FOR DOC FIX – Lawmakers are confident they’ll get another SGR patch if Washington can make a deal before Jan. 1. If there’s no deal, though, there’s no backup plan yet. http://politico.pro/XdVLwE

--GENERIC PAINKILLERS SPARK ABUSE CONCERNS — One ofthe most powerful and widely abused painkillers is slated to hit the market as a generic Jan. 1, and another follows in April. But they won’t have the anti-crush, abuse-deterrent features of the brand-name drugs they are competing with, and some legislators and activists say the generics could undo serious progress in the battle against the prescription drug abuse epidemic. http://politico.pro/VCUrSl

--HEALTH AFFAIRS: WORSE CARE FOR PATIENTS WITHOUT AFTER-HOURS PRIMARY DOCTOR — A new study in Health Affairs finds patients who can’t get in touch with their primary care doctors after regular office hours are more likely to end up in the ER — and less likely to get the care they need. http://politico.pro/VX4Y0X

HERITAGE TO STATES: PREPARE FOR ACA FAILURE – Ahead of the E&C hearing, the Heritage Foundation posted an explainer of why states should really think twice before setting up an exchange or expanding Medicaid. Here’s the shorthand: Instead of doing exchanges, states should “focus on creating a viable market for their citizens” if the ACA fails, and they should focus on improving the current Medicaid program instead of “throwing more people into a broken program.” The Heritage report: http://herit.ag/UCzjuU

KOFMAN TO HEAD D.C. EXCHANGE – Mila Kofman of the Georgetown University Health Policy Institute has been selected as the executive director of the District of Columbia Health Benefit Exchange, the board announced Wednesday night. Kofman, a former Maine insurance superintendent, starts on Jan. 2.

MASS. EXCHANGE HEAD, HHS CHIEF ON THE MOVE IN MAJOR SHAKEUP – Glen Shor, who has led Massachusetts’s insurance exchange since 2010, is leaving his post to run Gov. Deval Patrick’s budget office, according to reports. It’s part of a major second-term shakeup that includes the departure of Patrick’s longest-serving cabinet secretary, HHS chief JudyAnn Bigby. Shor joined the Connector in June 2010, succeeding the agency’s first executive director, Jon Kingsdale. As Patrick’s budget chief, Shor will still play a role in the Connector as the board’s chairman. The moves were disclosed just as the Connector prepares to vote on ways to conform to the ACA and as Massachusetts prepares to implement a closely watched, first-in-the-nation effort to control health care costs. The Boston Globe’s take on the changes: http://bo.st/TVpJHg

** A message from the Healthcare Education Project: What if there aren't enough doctors? What if families lose access to care in their community? Deficit reduction talks are putting Americans' healthcare at risk by proposing billions of Medicare cuts to physician training and hospital clinics. It's time to protect America's healthcare. http://www.healthcareeducationproject.org/ **

SENATE DEMS ANNOUNCE COMMITTEE ASSIGNMENTS – Sens. Sherrod Brown of Ohio and Michael Bennet of Colorado will join the Finance Committee in the 113th Congress. Newly elected Sens. Tammy Baldwin of Wisconsin, Christopher Murphy of Connecticut, and Elizabeth Warren of Massachusetts are joining the Senate HELP Committee. Patty Murray of Washington was officially named the new Budget Committee chairwoman.

NO MEDICAID EXPANSION FOR UTAH – Gov. Gary Herbert’s proposed budget released yesterday didn’t include any funding for the ACA’s Medicaid expansion. It did include, though, $19.4 million to fund the anticipated enrollment increase for those already eligible who haven’t signed up. The budget: http://1.usa.gov/SVkcjP

ARKANSAS GOING PARTNERSHIP, AFTER ALL – Democratic Gov. Mike Beebe, whose administration has been planning for a partnership exchange since last December, was hoping the election would give him legislative support for a fully state-run exchange. Well, it didn’t. “Right now the Legislature has indicated no desire to change anything to go to a pure state-run [exchange],” he told The Associated Press. So, Arkansas will go to the partnership route, but Beebe said the state could always revisit that decision. The AP story: http://bit.ly/SS2s7W

SMALL BIZ CHAIR: EHB RULE UNAFFORDABLE – Small businesses, including small insurers, will struggle to meet the Obama administration’s essential health benefits rule, House Committee on Small Business Chairman Sam Graves (R-Mo.) charges in a letter to HHS Secretary Kathleen Sebelius. Graves said small businesses will find it especially hard to supplement benefit categories they don’t traditionally cover, like mental health and substance abuse coverage, habilitative services and pediatric dental and vision care. “There are many small business owners who will struggle to afford any coverage, let alone the comprehensive or ‘supplemental’ coverage envisioned by the proposed rule,” Graves writes in a letter he’ll send today. The letter: http://1.usa.gov/Z0vNmF

MICHIGAN ‘OMNIBUS’ ABORTION BILL HEADED FOR PASSAGE — The Michigan state Senate passed a set of abortion restrictions Wednesday afternoon which would license and regulate abortion clinics as surgical facilities, prohibit abortions administered via telemedicine and require doctors to screen a patient to see if they’ve been coerced into having the procedure. The bill was passed by the state House this summer, and it now heads back to the House for a concurring vote in its amended form before going to Gov. Rick Snyder. The Michigan Catholic Conference cheered the bill’s Senate passage, saying in a statement it “places the dignity of women above the interests of the abortion industry.” Nancy Northup of the Center for Reproductive Rights decried it, saying in a statement, “Under the pretext of protecting women’s health, this bill would completely undermine women’s access to safe and affordable reproductive care.”

POLL: DON’T BOOST MEDICARE CO-PAYS — A new poll out this morning finds that voters oppose increasing fees on seniors’ Medicare services to cut federal spending. The poll — conducted by Public Policy Polling/Fabrizio Ward for the Partnership for Quality Home Healthcare — found that just 4 percent thought charging seniors an additional co-pay up to $150 was the best way to reduce Medicare spending. Other options that drew more support: requiring drug manufacturers to pay the government a rebate on prescription drugs (34 percent), gradually raising the eligibility age from 65 to 67 (30 percent) and charging higher premiums for wealthier seniors (22 percent). The poll: http://politico.pro/VXoElg

NATOMA CANFIELD VISITS WHITE HOUSE – From POLITICO’s Donovan Slack: “The Ohio woman whose name become a rallying cry for President Barack Obama in his fight for health care reform finally came to the White House on Wednesday to see a letter she wrote framed and placed on a West Wing wall outside the Oval Office.” The story: http://politi.co/VCXOZI

HARKIN THE OPTIMIST –A bunch of lawmakers are rearranging their Christmas travel plans, but not Sen. Tom Harkin. The HELP Committee chairman has a flight on Dec. 23, and he’s “certain” that he’ll make it. “I think there will some short-term-type thing that will get us through January and everybody will recognize that we can do that,” he said. Other members are … well, less optimistic. The POLITICO story: http://politi.co/Uacct4

WHAT WE’RE READING, by Brett Norman

Kaiser Health News asked a diverse group of experts what one change they would make to Medicare to control costs and why. http://bit.ly/QW9yts

Aetna says it expects to offer insurance plan in 15 state health exchanges, and that the expansion of the market is likely to contribute to its growth, Reuters reports. http://reut.rs/VBmRMQ

The Institute for Healthcare Improvement, formerly headed by Don Berwick, released a report yesterday on changes needed to make the federal health care law succeed, including better coordination among doctors and hospitals and more medical cost transparency, The Boston Globe reports. http://bo.st/SeRCvT

A New England Journal of Medicine article takes a critical look at the ramifications of an appellate court decision earlier this month allowing drug companies to market their products for off-label uses. http://bit.ly/UEi9Nu

Patients are coming forward with new health problems linked to the tainted steroid injections from New England Compounding Center — abscesses deep in the tissue where the injections were administered, the Boston Herald reports. http://bit.ly/QW9VV2

Nevada state Senate GOP leaders yesterday backed Gov. Brian Sandoval’s decision to expand Medicaid under the ACA, the first Republican governor to take the plunge, the Reno Gazette-Journal reports. http://on.rgj.com/Z1GsgQ

The United Nations passed a draft resolution, supported by the U.S., encouraging governments worldwide to move toward universal health insurance coverage. The Washington Post has the story. http://wapo.st/XTJHWe

** A message from the Healthcare Education Project: Deficit reduction talks are putting everyone's healthcare at risk by proposing drastic Medicare cuts to graduate medical education and hospital outpatient payments. America is already facing a physician shortage with a third of all doctors set to retire in the next decade and an aging population straining healthcare services. In many urban and rural communities hospital outpatient clinics are the only source of healthcare.

The $6.8 billion in cuts to these clinics ignore the added costs hospitals incur for caring for the uninsured and underinsured, and will force closures across the country. Fixing the debt by accelerating a looming doctor shortage and cutting care for patients isn't the answer.